Córdova documents a twenty-year transformation in how babies were born in Puerto Rico. In the middle of the twentieth century, Puerto Rico had twice as many midwives as registered doctors. At this time, birth was a home-based, family-oriented process that mothers accomplished with the assistance of midwives. By 1970, midwives had disappeared and the number of physicians tripled—a context that led to nearly every Puerto Rican baby (98%) being delivered in a hospital under the authority of an obstetrician. In contrast to births a couple decades before, hospital-based births in the 1970s were highly medicalized and directed by predominantly male biomedical practitioners. Then, after the 1980s, doctors’ fear of malpractice suits and corporate hospital concerns paved the way for a technocratic model of birth. In this corporate-legal framework, midwives were forced to recast themselves, or else face the disappearance of their profession. Pushing in Silence investigates the causes of these historical shifts with regards to Puerto Rican births, as well as the accompanying changes in attitude toward birthing, midwives, and doctors.
Vega, R. (2019). Isabel M. Córdova, Pushing in Silence: Modernizing Puerto Rico and the Medicalization of Childbirth (Austin, TX: University of Texas Press, 2017), pp. 234, $29.95, pb. Journal of Latin American Studies, 51(4), 978-980. doi:10.1017/S0022216X19001238
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Journal of Latin American Studies